It Takes A Village – Autism
Being a parent to an autistic child can be daunting, overwhelming and lonely. I say lonely, because even if you have a solid support system, nobody really knows how it feels. My hopes and aspirations for Kaylin are just as high, as for any of my other children, because I know my child and I know the potential she has. She was recently assessed, by an educational psychologist, and we were told that she is only capable of attending a “special” school, where they are taught a craft or trade, so they can get by in life. Well that was a kick in the gut, I wouldn’t wish on my worst enemy. Because while everyone else is complaining about how expensive school uniforms are, or how the school that “Johny” is attending doesn’t offer enough extra curricular activities, I’m standing here thinking “what am I going to do?” So yes it’s lonely, daunting and overwhelming, but we as parents, we knuckle down and we get on with it. However, knowing that there is a community of people out there, medical professionals included, who are supportive, patient and understanding makes a world of difference!
There’s a saying that goes it take a village to raise a child, well it takes an informed, open minded and tolerant village to raise an autistic child.
Written by Gretchen Hendricks[/vc_column_text][/vc_column][/vc_row]
- Published in Articles, Speech Therapy News
Swallowing and Feeding
Swallowing disorders are often the result of structural weakness or dysfunction and result in difficulty with the actual act of moving food from the mouth to the tummy. Whereas, a feeding disorder is often behaviorally motivated and results in the refusal of or an aversion to food. These conditions can be present in people of all ages but are most commonly seen in the pediatric and geriatric populations. Feeding and swallowing disorders can occur concurrently or independently of one another.
Swallowing Disorders
Swallowing disorders, also commonly referred to as Dysphagia, can result from decreased function of the oral, pharyngeal or esophageal structures.
Signs & Symptoms of Swallowing Disorders:
- Coughing or choking with food or liquid
- Wet vocal quality (gurgly voice)
- Runny nose or watery eyes with meals
- Food refusal or prolonged feeding times
- Pneumonia or respiratory problems
- Low grade fever following meals
- Abnormal oral feeding/ difficulty chewing
Assessment and Treatment
Swallowing disorders can be identified and treated by a Speech Language Pathologist. In some cases a Modified Barium Swallow Study or Video Fluoroscopic Swallow Study is recommended to further assess the swallowing mechanism. Treatment of swallowing difficulties focuses on identifying a cause, determining the safest diet, and improving swallowing skills. Treatment may include altering food or liquid consistencies, proper positioning, improving muscle strength, tone, and coordination, and teaching compensatory strategies.
Feeding Disorders
Feeding disorders differ from swallowing disorders in that they are often behavior based. However, feeding disorders often occur concurrently or as the result of a swallowing disorder. For example, a child who was fed via a feeding tube may be orally averse and therefore present with a feeding disorder.
Signs and Symptoms of Feeding Disorders:
- Food aversion or refusal
- Failure to advance to ageappropriate foods
- Negative mealtime behaviors
- Excessive vomiting
- Gagging or choking
- Failure To Thrive
Assessment and Treatment
Feeding disorders can be diagnosed and treated by a Speech-Language Pathologist. Treatment will focus on identifying the cause of the disorder, developing a plan to address both behavioral and physical concomitants, and educating the family and caregivers.[/vc_column_text][/vc_column][/vc_row]
- Published in Articles, Speech Therapy News
Laryngeal Cancer and Speech
What is Laryngeal Cancer?
This is essentially cancer of the voice box, where cancerous (malignant) cells form on the larynx, or voice box causing significant damage to the area and impeding speech. The larynx is made up of specialised folds, known as vocal cords that vibrate to create a sound when air passes through them. A person’s voice can be heard when this sound is echoed through the throat, mouth and nose.
Symptoms and Diagnosis
Individuals with laryngeal cancer may notice:
- a lump in their throat
- increased bad breath
- changes in their voice
- hoarseness
- shortness of breath
- difficulty swallowing and
- a bad cough or chest infection
The condition can be diagnosed by their doctor using an endoscope to observe the larynx for any abnormalities, this procedure is known as a laryngoscopy. The doctor may need to do a biopsy on a small selection of tissue, whereby the cells of the tissue are observed under a microscope to confirm whether it is cancerous or not.
Possible Treatments
One or more of these treatments may apply depending on the characteristics of the cancer itself – mainly the severity, size, location, and time of cancer detection:
- radiation therapy
- chemotherapy
- partial removal of the larynx (laryngectomy)
- total laryngectomy
In these cases, the patient may still be able to speak. However, the patient’s voice may not be the same due to the removal of parts of the larynx, changes to laryngeal tissue from radiation or chemotherapy, or removal of nearby neck muscles (to prevent or stop the spread of the cancer).
In extreme cases, total laryngectomy, with or without radiation therapy or chemotherapy, may be the only life-saving solution. This is the complete removal of the larynx or voice box and during this operation a new pathway for breathing is surgically created, where the end of the trachea (windpipe) is connected to the stoma (hole in the neck) for the patient to breathe through.
Causes and Occurrence
The risk of contracting Laryngeal Cancer is increased by a number of different contributors, including but not limited to:
- heavy smoking and drinking
- malnutrition or vitamin lacking diet where not enough raw food is being eaten
- a compromised immune system
- excessive exposure to harmful chemicals and certain substances (e.g., wood dust, paint fumes, soot)
- acid reflux
Cancers of the voice box or larynx make up about 2%-5% of diagnosed cancers. More than twice as many men as women are diagnosed. Most cases occur between the ages of 50 and 70.
Before and After Care
Once the severity of your condition has been accessed, your doctors will select the best treatment plan to combat the onset and spread of your cancer. Your Speech-Language-Therapist or SLP will explain the effects treatment will have on your speech and how it can be managed.
Speaking after a Laryngectomy
Your Speech-Language-Therapist will be present after surgery with alternative ways to communicate, such as a pen and paper to help you communicate in the early days. Once you’ve adjusted and recovered from surgery you can focus on developing your speech using the tools and exercises your SLP has recommended for you.
(Restoring your voice after surgery)
Esophageal speech:
This is the most basic form of speech rehabilitation and requires the patient to learn how to swallow air and force it through their mouth to create a sound. With training and assistance from your SLP these sounds can be used to form speech. However, new devices and surgical techniques often make learning esophageal speech unnecessary.
Tracheo-esophageal puncture (TEP):
This method is most commonly used to restore speech and can be done during the surgery or later. The surgeon creates a connection between the windpipe (trachea) and food pipe (oesophagus) by means of a small valve that is present at the stoma (puncture site in the neck). This allows patients to be able to force air from the lungs through the mouth. Simply covering the stoma with a finger allows the air to push through to the oral cavity to create a sound. With practice and training from your Speech-Language-Therapist you can regain the power to communicate freely.
Electrolarynx:
This is the mechanically assisted speech, so if you cannot have a TEP for medical reasons, or while you are learning to use your TEP voice, you may use an electrical device to produce a mechanical voice. This is a battery operated device that is placed in the corner of the mouth or against the skin in the neck to produce a mechanical voice. Your Speech-Language-Therapist will provide extensive training on how to use this properly.
- Published in Articles, Feature, Speech Therapy News
Speech-Language Therapy & Traumatic Brain Injury
Traumatic Brain Injury (TBI), also called head injury, occurs when a blow or jolt to the head damages the brain. TBI’s range in severity from mild to severe. Some effects can sometimes be permanent. TBI is the second highest cause of mortality, specifically in young men, in South Africa.
Problems that may follow a brain injury can include:
- Poor attention and memory
- Partial or complete loss of reading and writing skills
- Difficulty learning new things
- Swallowing problems
- Muscle weakness and coordination problems
- Seizures (also called traumatic epilepsy)
- Sleep problems
- Difficulty understanding spoken language
- Speech problems
- Difficulty with social skills
- Difficulty with controlling one’s emotions
- Irritability, frustration, and aggressive behaviour and mood swings
- Depression
What can the family do when caring for someone who has had a TBI?
- Don’t expect the person to be the same as before the brain injury.
- Develop a positive attitude.
- Don’t take their aggression or anger personally.
- Remember that it’s their injury talking, not the person.
- When they are angry, step back and walk away – it is best not to argue back.
- Don’t challenge the person directly.
- Encourage the person and praise them for every small improvement.
- Listen carefully to them when speaking without interrupting.
- Remember that they need lots of rest.
- Most importantly, be patient.
Speech-Language Therapy can help by:
- Assisting with feeding and swallowing difficulties
- Providing cognitive rehabilitation to improve thinking and memory skills
- Providing therapy to improve understanding of language
- Providing therapy to improve speech production
- And most importantly, providing family counselling and education
It is important to remember that rehabilitation is a long term process that can take months and sometimes even years.
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Samantha de Freitas
Speech and Language Therapist
Samantha de Freitas is a Speech and Language Therapist qualified at UCT in 2012. Currently she specialises in AAC
[/fullwidth_text]- Published in Articles, Speech Therapy News
Stroke and Its Effect on Communication
A stroke occurs when a blood vessel supplying oxygen and nutrients to the brain either bursts or becomes clogged with a blood clot. The effects of a stroke can range from mild to severe. One of the biggest effects is on the individual’s ability to communicate after the stroke. The three most prominent effects that a Speech-Language Therapist deals with include: Aphasia, Apraxia, and Dysarthria.
Aphasia is a disorder that results from damage to the language areas of the brain. This means that the stroke most likely occurred in the left hemisphere of the brain. Aphasia can disrupt receptive language, expressive language, or both. Receptive language is the ability to understand what is being said or to understand what one is reading. Expressive language is the ability to express one’s thoughts and feelings through speech or through writing.
Apraxia is a motor speech disorder that is caused by damage to the parts of the nervous system that are related to speaking. It is characterised by problems sequencing the sounds in syllables and words. People with Apraxia know what words they want to say, but their brains have difficulty co-ordinating the muscle movements necessary to say those words and they may say something different and even non-sensical.
Dysarthria is a speech disorder that is due to a weakness or incoordination of the speech muscles. People with Dysarthria will have slow, weak, imprecise or uncoordinated speech. Their speech often sounds effortful and depending on severity, unintelligible. Drooling is also a common occurrence in those with Dysarthria.
If you suspect that someone you are caring for has any of these conditions with their communication, it is important that they be referred for assessment by a Speech-Language Therapist. Once the individual is attended to and receives therapy, these conditions can improve.
Apart from trouble speaking or understanding, other warning signs to look out for that indicates a stroke may be occurring include: headaches; dizziness; loss of balance; difficulty walking; sudden confusion; sudden trouble seeing in one or both eyes; sudden numbness or weakness in the face, arm or leg, especially on one side of the body only.
[/fullwidth_text] [fullwidth_text alt_background=”none” width=”1/1″ el_position=”first last”]
Samantha de Freitas
Speech and Language Therapist
Samantha de Freitas is a Speech and Language Therapist qualified at UCT in 2012. Currently she specialises in AAC
[/fullwidth_text]- Published in Articles, Speech Therapy News, Voice Disorders
Meaningful Milestones
The range of development is wide. Every child is unique in their stengths and weakness in their development. It is of little significance if one or two areas are delayed. Professional opinion should be sort after if there is a delay in a number of areas such as a lack on comprehension, absence of play and no interest in the environment.
At 1 year
- Understand what the word “NO” means and regularly obeys it
- Understand his/her name and turns head or makes eye contact when it is used.
- Babbles in a foreign language
- Understands “Give to mummy/daddy” when it is accompanied by a gesture.
- Uses one or two words with meaning and says “Da da”.
- Is able to wave “bye-bye” and enjoys playing Peek-a-boo
Seek expert advice if:
- If there is no babbling
- It appears as if the child cannot hear.
- Disinterest in the environment
- The child is not developing to the brother and sister at the same age.
At 18 months
- Talks to himself/herself in his/her own language
- Use 6-20 appropriate words (appropriate words doe not include repeating what mommy or daddy has said)
- Is able to point to feet, nose, shoes and hair when requested to do so.
- Can follow one word verbal command
- Is able to point to pictures in a book e.g. banana
- This is not the age to reason with them. They do not know what they want.
At 24 months/ 2 years
- Loves looking at picture books
- 50 words in vocabulary and understands many more
- Occasionally uses 2-3 word sentences
- Call himself/herself by Name
- Sings along in nursery rhymes and song
- Is able to deliver short messages such as “Mummy give”
- Says when wants to use the potty
- Plays beside and not directly with others
Seek expert advice if:
- There is very little speech or no speech at all
- Mouthing of toys still occurs
- Toys are thrown in an unlikely way
- If play is repetitive
- There is a disinterest in the environment
- Body language is absent
- Strange irritability
At 28 months/ 2 years 6 months
- Makes use of 200 words and more
- Makes use of “I”, “Me” and “You”.
- Knows his name and surname
- Stuttering may occur due to eagerness to speak
- Play next to other children and not with them.
- Does not understand the concept of sharing
- Cannot wait for things, expects everything immediately
At 3 years
- Stranger is able to understand the child
- Use plurals correctly e.g. dogs, cats etc
- Will volunteer to give name, surname and sex
- Talks to himself/herself while playing
- In a simple but reliable manner able to describe an event.
- Starts asking question like “what?’, “why?”
- Enjoys listening to stories and loves hearing a favourite story told over and over again.
- Recites nursery rhymes
- Can count to 10 in rote.
Seek Professional Advice if:
- He/she she is unable to communicate using speech
- Poor body language
- Shows little imagination and makes use of repetitive play
- Behaviour is similar to that of a 18 month old e.g. refuses to share and senseless behaviour.
At 4 years
- Is able to name 4 primary colours
- Grammar and speech is used correctly
- A sounds are pronounced incorrectly e.g. the /r/ sound is produced as a /w/. He or she may /wabbit/ instead of /rabbit/
- Is able describe an event accurately and logically
- Can provide address and age
- Constantly asking question: What? Where? What? How?
- Enjoys listening to stories
- Confuses facts and fiction when telling stories
- Understands today, yesterday and tomorrow
- Enjoys listening to joke.
- Is able to count en rote till 20 and is able to count till 5 objects meaningfully.
Reference: Children’s Developmental Progress, Mary Sheridan (N.F.E.R. Publishing Co.,UK)
- Published in Articles, Development, Speech Therapy News
The Importance of a Case History (Background Information) in a Speech and Language Assessment
Before we initiate testing, we firstly administer an in depth case history (collecting background information) with the parents. The Case History identifies any red flags that may be a factor or a contributing factor to Speech and Language difficulties. The Case history may take 15 minutes to 30 minutes before the Speech Therapist starts to testing the child. The more information the parent is able to give the therapist during this 30 minute session, the better the diagnosis will be. In most cases the collection of information during the Case History provides is more important than the testing as it gives the therapist an indication of what Speech and Language difficulty to look out for.
What does the Case History consist of?
The Case History consists of the following:
- General Background information- What is the child’s home language? What are the parents occupations? What are the parents ages? Who does the child live with? Does the child have siblings? etc.
- Prenatal and Birth History- What was the mother’s health like during pregnancy? Birth weight? Type of Delivery? etc.
- Medical History- Was the child ever hospitalized? Did he/she suffer from ear infections? Is she on any form of medication? etc.
- Developmental History – When did he start to sit, crawl, stand and walk? When did she start to use single words? etc.
- Educational History – What school does she attend? How is the child’s performance at school? Doe he attend any special classes? etc.
The collection of background information provides the key to the puzzle in identifying what may be the child’s difficulty and the cause of the difficulty. Without background information children may continue to struggle to incorrect diagnosis and inappropriate intervention. For accurate diagnosis it is important that the therapist collects a detailed case history of the child’s development and family history. This will ensure that the child will receive therapy relevant to his/her needs.
- Published in Articles, Feature, Speech Therapy News